A New Form of Food Reactivity

Wednesday, 10 April 2013 by

Food Protein Enterocolitis (FPIES) may be a new term to you, but as with a number of emerging subsets of food reactivity it appears to be a little over half as common as IgE food responses (0.34% by 1 year of age; immunoglobulin E-mediated cow’s milk allergy was 0.5%.). So whilst you may not see a case directly in practice, understanding its process and symptoms as well as treatments will prepare you for those cases that seem to fail to respond to normal approaches.

Food Protein Induced Enterocolitis Syndrome (FPIES) is an allergic reaction in the gastrointestinal system. The most common triggers are milk and soy, but any food (even those thought to be hypoallergenic e.g. rice, oat) can cause an FPIES reaction. FPIES typically starts within the first year of life.[1]

Long implicated in numerous adverse events linked to intestinal immunity and associated mucosal tolerance a recent presentation at the American Academy of Allergy Asthma &Immunology annual meeting has shown a credible causation link between antibiotics and allergy.[1]

In their retrospective case–control study, presented as a late-breaking abstract at the meeting, Dr. Love and colleagues found an almost 2-fold increase in food allergy in children exposed to 3 or more courses of antibiotics between the ages of 7 and 12 months.

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The LEAP Project

Many Nutritional Therapists will consult people with a well-defined allergy or in some cases a range of symptoms that reflect an allergic response that do not meet the recognised IgE diagnosis. Some of these people will also be experiencing what is known as the ‘allergic march’ – the development of secondary allergenic profiles such as asthma after already having an established food allergy, such as peanut or shellfish.

Asthma Management

Monday, 22 August 2011 by

The incidence of asthma and allergy are on the rise with ever increasing understanding of the role of unique genetic changes to epithelial tissues and environmental impacts including nutrition and bacteria.[1]

But aside from the choices f intervention, asthma management is all about limiting the triggers managing the symptoms and helping to maintain function. Helping the individuals to avoid hospital visits, experience adverse effects of medication are also important.

You should keep in mind that there are a small number of steps that it is worth either undertaking directly with your patient or referring them to their GP or specialist.

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In one more of the rapidly developing field of immunotherapy in the treatment of allergy by training the oral tolerance mechanisms in our bodies, a group of 22 children (median age 11) with peanut allergies were fed under medical supervision a dose of peanuts made into flour and mixed in chocolate over several months.[1]

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Many people suffer from an allergy to cow’s milk and other common foods, and whilst avoidance of the trigger has long been seen as the gold standard of management an evolving mechanism for treatment is being developed using oral tolerance triggers to restore food exposure competence.

Studies in several clinical trials in allergen-sublingual immunotherapy (SIT) have demonstrated that the induction of a tolerant state against allergens in many ways represents a key step in the development of a healthy immune response against allergens. Several cellular and molecular mechanisms have been demonstrated: allergen-specific suppressive capacities of both inducible subsets of CD4(+) CD25(+) forkhead box P3(+) T-regulatory and IL-10-secreting type 1 T-regulatory cells increase in peripheral blood; suppression of eosinophils, mast cells, and basophils; Antibody isotype change from IgE to IgG4.[1]

A food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.

New guidelines from an expert panel sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) aim to standardise the diagnosis and management of food allergy across clinical care settings.[1] The recommendations also addressed the use of multiple types of tests for reaching a diagnosis for IgE-mediated food allergy:

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Brief Explanation of Food Allergy

Monday, 29 November 2010 by

From a medical perspective food allergy is an immunoglobulin (Ig)E- or non-IgE-mediated immune response to food protein. This small review will look at the IgE mediated food represented by immediate hypersensitivity (Gell-Coombs Type I), which can include anaphylaxis and can be life-threatening.

Food or environmental exposures that result in non-IgE-mediated reactions are thought to be cell mediated (allergic eosinophilic esophagitis/gastroenteritis, food protein-induced proctocolitis, food protein-induced enterocolitis syndrome, food protein-induced enteropathy; including coeliac disease).

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As if the burdens of age are not tiresome enough, the idea that we ‘grow out’ of allergies appears to be proving to be a reversible event.

Age-related immunoglobulin (Ig)E levels have risen significantly in both males and females in the United States since the 1970s, researchers announced at the American College of Allergy, Asthma & Immunology (ACAAI) 2010 Annual Scientific Meeting.

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The fact we are not ill more often is due to the remarkable capacity our bodies have to revert to a state of ‘homeostasis’ – a somewhat dull word provided by Walter Cannon in the early 20th century to summarise the work of the physiologist Claude Bernard who was based in Paris in the 1850s. It has dominated biology, physiology and medicine ever since. Homeostasis is regularly used to describe the exquisite intrinsic ability we possess to respond to, counteract and adapt to external and internal sources of damage and disturbance to maintain health/function in us and other living organisms.

A more contemporary – albeit controversial term to describe this is: ‘Homeodynamics’.[1] This is the concept that we are not static but constantly adapting. Homeodynamics, accounts for the fact that the internal milieu of complex biological systems is not permanently fixed, is not at equilibrium, and is subject to dynamic regulation and interaction among various levels of organisation. Aging, senescence and death are the final manifestations of unsuccessful homeodynamics and in utero exposure represents the first opportunity and experience  for remodelling and constant adaptation.